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Biomedical subjects

V A Loening-Baucke

Publications and source records attributed to V A Loening-Baucke.

9 recordsLinked to original sources
PubMed1987

Changes in colorectal function in patients with chronic colonic pseudoobstruction.

Motility studies of the lower bowel, radiology to exclude other gastrointestinal involvement, and rectal biopsies were carried out in 11 patients, age 21-60 years, with isolated chronic colonic pseudoobstruction. Repeated plain abdominal x-rays during symptomatic periods revealed massive gaseous colonic distension in all. Seven patients had the primary form while four patients had an underlying disease which could have been responsible for the chronic colonic pseudoobstruction. Lower bowel motility was decreased in patients with the primary form. Rectal wall elasticity was increased in both the primary and secondary form. Some of the abnormalities measured may suggest myogenic abnormalities of the sigmoid or rectal wall. No specific neural or muscular morphologic defect was identified in colonic transmural sections in eight patients except in the patient with Hirschsprung's disease. Five of seven patients with primary colonic pseudoobstruction achieved symptomatic relief only after subtotal colectomy and ileoproctostomy.

Adult↗
PubMed1986

Abnormal defecation dynamics in chronically constipated children with encopresis.

We studied the ability to defecate water-filled balloons in 16 healthy and 37 chronically constipated children with encopresis. The act of bearing down for defecation was evaluated by measuring intra-abdominal pressure, rectal pressure, anal pressure, external anal sphincter EMG activity, and rectal sensation and rectal volume necessary to inhibit the anal sphincters. Fifteen control children and 20 constipated children were able to defecate rectal balloons. External sphincter activity decreased during the act of bearing down for defecation in 100% of controls, in 58% of constipated children able to defecate balloons, and in only 7% of patients unable to defecate balloons. Constipated children unable to defecate balloons were significantly less likely to recover after conventional laxative treatment than constipated children able to defecate balloons (P less than 0.02). Increased external sphincter activity during defecation appears to be the factor that prevents balloon expulsion in constipated children and could be the cause of their chronic fecal retention.

Anal Canal↗
PubMed1984

Sensitivity of the sigmoid colon and rectum in children treated for chronic constipation.

Sensations in the sigmoid and rectum and the response of the anal canal to balloon distension were measured with a latex balloon and pressure transducer in 15 chronically constipated and 15 healthy control children. The constipated children received milk of magnesia and bowel training. Thirteen constipated children were restudied 7-12 months later and 11 were restudied 3 years later. Although thresholds of transient sensation and of the rectosphincteric reflex were not different in constipated and control children, the threshold of fullness, the critical volume, and the volume for constant relaxation were significantly higher in constipated than in control children (p less than 0.05), and remained higher 1 year and 3 years later, even in the children who recovered. The initial data support the concept of a sigmoid and rectum so enlarged that a normal fecal bolus may not cause a sensation of fullness or a sensory stimulus for defecation. Despite improvement in clinical manifestations and normal rectal size, the abnormalities in sensitivity of the sigmoid and rectum persisted in five of eight recovered children. This may explain why these children are so vulnerable to recurrence of constipation and fecal soiling.

Anal Canal↗
PubMed1984

Abnormal rectoanal function in children recovered from chronic constipation and encopresis.

It is unknown if abnormal anal sphincter function as assessed by anorectal manometry is still present years after resolution of chronic constipation and encopresis. Twenty healthy controls, 12 children with constipation but no encopresis, and 20 children with chronic constipation and encopresis underwent anorectal manometric testing, using intraluminal pressure transducers and a balloon for rectal distention. Anorectal measurements were repeated in the 20 constipated and encopretic children 2.5-4 yr after treatment began; 11 children had recovered for at least 1 yr. The mean values of anal resting tone and of anal pull-through pressure were lower in the constipated and encopretic children than in the 20 control children (p less than 0.003). Percent relaxation of the rectosphincteric reflex after rectal distention of 30 and 60 ml was lower in constipated children with and without encopresis than in controls (p less than 0.003), whereas the means of rectosphincteric reflex threshold were comparable in the three groups of children. Three years after initiation of treatment with milk of magnesia, high-fiber diet, and bowel training techniques, the mean values of anal resting tone, anal pull-through pressure, and percent relaxation of rectosphincteric reflex remained significantly lower in both recovered and nonrecovered constipated and encopretic patients compared with controls. It was suggested that the underlying cause of chronic constipation is the decreased ability of the internal anal sphincter to relax with rectal distention, and the hypotonia of the anal canal is responsible for the encopresis. Abnormal anorectal functions were still present years after cessation of treatment and recovery and put the recovered patient at risk for recurrence of chronic constipation and encopresis.

Anal Canal↗
PubMed1984

Effect of treatment on rectal and sigmoid motility in chronically constipated children.

Using three pressure transducers, motility of the lower and upper rectum and sigmoid was recorded in 18 healthy and 18 chronically constipated children. The 36 children had a wide range of values for frequency of contractions, duration, amplitude, percent of activity, and surface area under the contraction curves. The mean values for percent of activity and surface area were significantly lower in the constipated than in the control children in all three recording areas (P less than .05). Motility in the constipated children, after 2 months of treatment that included milk of magnesia, showed significant increase when compared with corresponding pretreatment values (P less than .05), and were not different from corresponding values of the control children (P greater than .1). Seven to 12 months and 3 years later, rectal and sigmoid motility remained normal. Three-year follow-up revealed that most of the constipated children were not completely free of constipation and fecal soiling in spite of normal motility. Therefore, it appears that the hypomotility in the untreated patients was the result of the chronic fecal impaction and rectal distension and while it was not the cause of the constipation, it may have contributed to its severity.

Bisacodyl↗
PubMed1983

Anorectal manometry: experience with strain gauge pressure transducers for the diagnosis of Hirschsprung's disease.

An esophageal pressure transducer with three strain gauges was used in the anal canal to study the rectosphincteric reflex (RSR) in five infants and children with intestinal obstruction, 142 children age one day to 18 years with moderate to severe constipation and in 18 healthy control children 4 to 12 years of age. The RSR was present in the four newborns with intestinal obstruction in 133 of the constipated children, and in all healthy controls. The mean (+/- SD) minimal volume of air in the rectal balloon required to produce RSR greater than or equal to 5 mm Hg (RSRT) was 9 mL (+/- 2) for infants 0 to 2 years, 14 mL (+/- 4) for children 2 to 4 years, 15 mL (+/- 6) for children 4 to 12 years, and 14 mL (+/- 6) for children 12 to 18 years of age. The RSRT for control children was 13 mL (+/- 4). The volume of air used in rectal balloon distension correlated with the amplitude of the RSR for control (r = 0.7131) and constipated children (r = 0.6289). The amplitudes of the RSR for the controls were significantly higher than the amplitudes for constipated children for rectal distension volumes between 60 and 15 cc (p less than 0.01). The 10 children with absent RSR had Hirschsprung's disease confirmed at surgery. Measurements of RSR could be used to separate patients with chronic constipation from patients with Hirschsprung's disease.

Adolescent↗
PubMed1982

Abnormal and sphincter response in chronically constipated children.

Using a strain gauge, we measured anal sphincter function in 116 chronically constipated and 18 healthy children. Eighteen constipated children were re-evaluated two months later (receiving laxative), and 15 were again studied seven to 12 months later. The anal resting tone varied along the length of the anal canal and was highest at 1 to 1.5 cm from the anal verge. This region was used to study the resting motor activity of the internal anal sphincter, the amplitude of the rectosphincteric reflex after 30 and 60 ml rectal distension, and the rectosphincteric reflex threshold. The mean and resting tone was significantly lower in constipated than in control children (P less than 0.001), but normalized in patients who recovered. Resting motor activity of the internal anal sphincter and the amplitude of RSR were significantly lower in constipated patients than were the corresponding values in control children (P less than 0.001), and remained lower during and after treatment, even in patients who recovered. The length of the anal canal and the RSR threshold were comparable in control and constipated children. Thus, the basic problem in chronically constipated children appears to be an abnormal internal anal sphincter, which is weaker and less responsive to rectal distension than in nonconstipated children.

Adolescent↗
PubMedDate not supplied

Factors responsible for persistence of childhood constipation.

In this study 56% of children with chronic constipation and encopresis were unable to defecate rectal balloons. Most of them had an abnormal contraction of the external and sphincter during defecation trials. Eighty-six percent were still unable to defecate balloons 1 year later after having complied with a conventional treatment program. Only 14% of patients unable to defecate balloons had recovered by 1 year, whereas 64% of patients able to had recovered (p less than 0.02). Only 13% of patients unable to relax the external sphincter had recovered by 1 year, whereas 70% of those able to do so had recovered (p less than 0.01). In addition, none of the patients with an abdominal fecal mass present during the initial examination independent of ability or inability to defecate balloons had recovered (p less than 0.001). This study shows that abnormal defecation dynamics and the severity of constipation are predictors for persistence of chronic constipation and encopresis.

Adolescent↗